Showing posts with label accountants. Show all posts
Showing posts with label accountants. Show all posts

Saturday, October 10, 2020

Impact of endometrioma and bilaterality on IVF/ICSI cycles

A Turkish study has found that that presence of endometrioma in patients with endometriosis negatively impacts fertility parameters, but has no effect on embryo quality, clinical pregnancy rates (PR), or live birth rates (LBR)1.


The study in the Journal of Gynecology Obstetrics and Human Reproduction also concluded bilaterality does not influence any fertility parameters or PR.



Done retrospectively, the researchers sought to investigate the effects of endometrioma and the impact of bilaterality on in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) outcomes.

A total of 159 women who underwent IVF/CSI cycles at Zekai Tahir Burak Women’s Health Education and Research Hospital in Ankara, Turkey, between March 2015 and March 2018, were recruited for the study.

Patients were divided into two groups: the study group (n = 73) of infertile women with either unilateral or bilateral ovarian endometrioma with any IVF indication; and the control group (n = 86) without endometrioma.

Basal follicle-stimulating hormone (FSH) levels and total gonadotropin doses used during ovarian stimulation were significantly higher and antral follicle count (AFC) was significantly lower in the study group compared to the control group.

But the differences in these variables between the unilateral (n = 43) and the bilateral (n = 30) endometrioma group were non-significant.

Anti-Müllerian hormone (AMH) levels for unilateral and bilateral endometrioma were also comparable: 1.4 ng/ML and 1.23 ng/mL, respectively.

However, the number of endometriomas > 4 cm was significantly higher in the bilateral than in the unilateral group.

The study also found that the number of dominant follicles at trigger day and total oocyte retrieved were significantly higher in the control group than in the study group. But when compared between the unilateral and the bilateral endometrioma group, these differences were insignificant.

Still, the number of metaphase II (MII) oocytes was significantly higher in the control group compared to the unilateral group, whereas the difference was non-significant between the control group and the bilateral group.

For all procedures, sperm was obtained via ejaculation, and there were no cycles cancelled in the control group. However, in the study group, 12 cycles were cancelled because fertilized embryos could not be procured: 6 cycles each from the unilateral and bilateral group.

There were also four patients in the study group with no dominant follicle development, two each from the unilateral and bilateral group.

In addition, there were eight total fertilization failures, four each from the two groups.

“Given the higher cancelling rates, the prognosis for patients with endometrioma seems to be worse than in patients without endometrioma,” wrote the authors.

On the other hand, the number of embryos achieved and blastocysts obtained were similar between the three groups (no laterality, unilateral and bilateral), as were rates of pregnancy, live birth, and early pregnancy loss.

There was also no statistically significant difference between the control and the unilateral groups for all grades of embryo.

However, the number of grade 2 embryos was significantly lower in the bilateral group compared to the control group. But for blastocyst and grade 1 embryo numbers, the bilateral group had comparable findings to the other two groups.

“Based on our results, we speculate that bilaterality doesn’t exert additional damage on ovarian reserve more than unilateral endometrioma does,” wrote the authors.



Reference

Yilmaz N, Ceran MU, Ugurlu EN, et al. Impact of endometrioma and bilaterality on IVF/ICSI cycles in patients with endometriosis. J Gynecol Obstet Hum Reprod. Published online June 30, 2020. doi:10.101

Medical Practice Supplies


VIEW ALL



Manual Prescription Pad (Large - Yellow)


Manual Prescription Pad (Large - Pink)

Manual Prescription Pads (Bright Orange)

Manual Prescription Pads (Light Pink)

Manual Prescription Pads (Light Yellow)

Manual Prescription Pad (Large - Blue)

Manual Prescription Pad (Large - White)


VIEW ALL

.
Posted by at No comments:
Labels: , , , , , , , , , , , , , , , ,

Maintaining adolescent confidentiality in care

A presentation at the virtual 2020 American Academy of Pediatrics National Conference and Exhibition showed how two health care systems walk the line to protect their adolescent patients’ right to privacy.


Especially for ob/gyns, maintaining patient privacy is crucial. Adolescent patients may be concerned about this, especially if the nature of the visit is especially personal. Will their parents find out about their STD test results?


During the presentation “Mum’s the word: Adolescent consent to care and confidentiality (and EHRs)” at the virtual 2020 American Academy of Pediatrics National Conference & Exhibition, Ryan H. Pasternak, MD, MPH, FAAP, professor of clinical pediatrics at the Louisiana State University School of Medicine in New Orleans, and Kirsten B. Hawkins, MD, MPH, FAAP, FSAHM, discussed how the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule affects adolescent confidentiality, the 21st Century CURES act and electronic health records, and how their health systems protected adolescent confidentiality.

Medical Practice Supplies


VIEW ALL



Manual Prescription Pad (Large - Yellow)


Manual Prescription Pad (Large - Pink)

Manual Prescription Pads (Bright Orange)

Manual Prescription Pads (Light Pink)

Manual Prescription Pads (Light Yellow)

Manual Prescription Pad (Large - Blue)

Manual Prescription Pad (Large - White)


VIEW ALL

.
Posted by at No comments:
Labels: , , , , , , , , , , , , , , , ,

Friday, October 9, 2020

Mastering the art of negotiation

Negotiations are essentially human interactions seeking to discuss deals. Physicians often call me when they want assistance negotiating a deal (perhaps for a merger with another practice, an acquisition by a hospital, a partnership with private equity, or even as part of internal physician governance matters). Sure, there is experience involved, but these are learned skills which everyone can practice and benefit from over time.


This article will cover just some of these tactics and skills which physicians may want to utilize the next time they find themselves in need of negotiations.

Fundamentals


First, note that it is common to feel like you are “bad at negotiating” as indeed the very idea of negotiating often makes many of us feel uncomfortable, awkward, or anxious. Fundamentally, negotiation is actually not about money, or deal terms, or even “winning”, but rather about creating a relationship where both sides get the best result. The central rule of every negotiation is to create agreement between parties with different interests and objectives. All that's required of you is the ability to provide value to the other party and the willingness to step out of your comfort zone to get things done.


Strategy


Jumping straight into negotiations is ill-advised. Before you start negotiations, you need to have a clear idea of what your priorities are. There are lot of ways to organize these, but the easiest way is to rank what you want from highest to lowest priority as this helps you stay clear on exactly what’s most important for your specific needs. It is easy to enter a negotiation thinking one thing, only to agree to something far less than you had hoped for. By writing down a list of your priorities in order, you can be sure the items at the top of the list stay in place, and you only compromise on the lower items.

Once you have a solid understanding of your priorities and those of the other party, you need to create the offer. I have found that most physicians discover this during the negotiation process, but you’ll be more powerful if you can plan this in advance. The more prepared you are before you walk into the negotiation, the better you will be able to make your decisions. Doing your homework will give you ideas on exactly what the other party wants and needs. If you have to make a decision on the spot in your negotiation, you’re going to struggle to make the right choices each time. Instead, decide ahead of time exactly where you’re willing to compromise, and where you’re firm.

Equally important is to remember that price is not the only factor. For example, if you are merging your practice with another entity and you have nurse practitioners currently in your group, it may be very important that those personnel are maintained in the transition. Or, if you are allowing another physician to buy into your practice, you may want to maintain some control over certain voting rights. Perhaps your practice maintains a presence at skilled nursing facilities and as part of the sale of your group to the hospital, you want to be able to continue to see patients at those nursing homes. These are all illustrations of items that have nothing to do with the “negotiation price”.

Walking away


Based on your strategy, you should have some firm “lines in the sand” at which you are willing to walk away from the deal. To be clear, this is not that you must have everything your way, otherwise it would not be called negotiation; however, you have to know what your deal breakers are. If you don’t draw a firm line in the sand before you invest your time and energy into a negotiation, you are at risk of eventually losing track of what is good for your practice and will end up making concessions that hurt your own interests. Not all deals are meant to get done.

To go a step further, think about what the other party’s walk-away point is too. So often, we get caught up in what we need and what we want. But think about what is going to happen if the other party does not get this deal done, because that allows you to find out where they are flexible and where they are not.

Listen


To be blunt, close your mouth and just listen. Using silence in negotiations is a skill. Don’t go into a negotiation feeling like you should do all the talking. Sometimes the best thing you can do when negotiating is to keep quiet. For example, if the other party presents a ridiculously bad offer then waits for your response, just keep your mouth shut and let them drown in awkward silence.

When you want your point of view acknowledged, acknowledge theirs first. You should be listening and asking lots of questions. To be fair, this is where experienced consultants add a lot of value because they have seen many deals and know which questions to ask. The goal is to understand what the other party’s circumstances are. What are their constraints? What are their timelines? What are they up against? It will help you frame how to get to the right results. When you acknowledge their point of view first, it helps bridge the gap and they will be more receptive to hearing your point of view. Remember to listen carefully for potential flexibility the other party may have.

Maintain emotional control


Oftentimes, negotiations become heated. While there are ways to de-escalate them, it’s much easier to keep a steady composure no matter what happens. My suggestion is to remain steady throughout the negotiation and look to perceive exactly what the other party is communicating. You should strive to keep both positive and negative emotions in check. Also, clarify any communication you don’t understand immediately so that your emotions don’t run wild based on your own misinterpretation.


Never negotiate alone


Even if you opt not to use a consultant, make sure you do not negotiate by yourself. Negotiations consume time and energy and the longer you have been engaged in the process, the more emotionally invested you become in making a deal happen. No one is immune to this, which is why it is important to have someone else with you during the discussions.

Final thoughts


Negotiations in the healthcare space can be difficult to manage properly and are often twisted with misunderstanding and miscommunication. Unfortunately, when it comes to negotiations, we usually think we’re better than we are, and we end up settling in the negotiation process. But that doesn’t need to be true for you and hopefully you have picked up a few tips in this article.

Lastly, keep a perspective on the fact that you may continue to be practicing in the same community after your negotiations (whether they were successful discussions or not). While it may make sense to be firm in the midst of the negotiation, always have a limit on how tense the negotiation is (another good reason to have a calm-headed consultant by your side).

Medical Practice Supplies


VIEW ALL



Manual Prescription Pad (Large - Yellow)


Manual Prescription Pad (Large - Pink)

Manual Prescription Pads (Bright Orange)

Manual Prescription Pads (Light Pink)

Manual Prescription Pads (Light Yellow)

Manual Prescription Pad (Large - Blue)

Manual Prescription Pad (Large - White)


VIEW ALL

.
Posted by at No comments:
Labels: , , , , , , , , , , , , , , ,
Subscribe to: Posts (Atom)